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Drug diversion and the poor

Last week I participated in an expert panel meeting at the Centers for Disease Control & Prevention on the issue of prescription drug abuse and its impact on Medicaid programs.

The new director of the CDC has deemed drug diversion one of six public-health issues that CDC has embraced for study and action in 2012. The meeting included some very smart people from CDC, mostly medical experts, plus representatives from a handful of state Medicaid programs and a few private payers.

Drug diversion is a huge problem for Medicaid. A third to a half of all prescription drug deaths in the U.S. are Medicaid recipients. Eighty percent of babies born addicted to prescription drugs are born to mothers on Medicaid. The prescription rate among patients on Medicaid is more than twice that of the private sector. No doubt many of those pills end up on the street.

One of the most effective tools Medicaid programs have to curb diversion is requiring patients to use only one physician and one pharmacist for their prescriptions. Such “lock-in” requirements help stem doctor shopping.

But there are two problems with such programs. First, they don’t exist in many states because doctors and pharmacists sometimes don’t like them and their lobbies help to either kill lock-in legislation or weakened the bills.

Second, lock-in programs don’t catch Medicaid patients who intentionally avoid detection by paying for their illicit prescriptions in cash. Prescription monitoring programs (PMPs) — in which doctors and pharmacists log prescription activity into a state database — can catch such transactions.

But surprisingly, all but one state Medicaid program are denied access to PMP data mostly because of privacy concerns. That’s a huge missed opportunity to catch drug abusers early, and save taxpayer dollars and perhaps a few lives.

PMPs, health regulators and state legislators need to consider giving Medicaid programs access to drug data so they can become full partners in combating fraud and abuse involving prescription drugs.

About the author:Dennis Jay is executive director for the Coalition Against Insurance Fraud.